Admission to a nursing home represents a crisis point with implications for physical recovery, mental illness, and quality of life. In this project, we will follow a sample of nursing home residents from admission through the first year of nursing home residence. Our purpose is to examine not only predictors of traditional mental illness and well-being outcomes, but also what factors determine the shape and direction of change over time for individual residents. There are two specific aims: (1) to identify psychological, social, physical, and demographic resources and processes that promote resilience and predict change in mental illness (depression and anxiety) and mortality during the year following admission to a nursing home; and (2) to identify psychological, social, physical, and demographic resilience resources and processes that predict change in flourishing (quality of life, positive affect, and social engagement). We will collect data from 400 newly admitted nursing home residents, their families, nursing home staff members, and from medical charts. These data will include residents' pre-admission psychological, social, and physical characteristics that will facilitate or detract from their capacity for resilience, including demographic and personality characteristics, social networks, physical health and disability, cognitive impairment and mental health history. We will evaluate levels of depression, anxiety and quality of life at admission, and then measure resident experiences with treatment, activity, and social interactions during the nursing home stay, and resident regulation of positive and negative affect that should promote resilience. We will also use blood draws to collect information on biomarkers indicative of stress response at the time of admission and after a year. We will assess residents quarterly for one year, a total of 4 assessments after the baseline evaluation. Results of this study will contribute to improving care for older adults who enter nursing facilities in three ways. First, results will highlight attributes associated with resilience and risk that can be measured at the time of admission and used to prioritize interventions. Second, we will identify resiliency processes that are potential treatment targets for improving mental illness outcomes and promote flourishing. Finally, inclusion of indicators of flourishing in addition to measures of mental illness will permit conceptual exploration of the notion of flourishing at the end of life, broadening our goals for care to include not only absence of mental illness, but also the promotion of well-being. PUBLIC HEALTH RELEVANCE: Forty-five percent of Americans over the age of 65 will use a nursing home in 2010, and about 24% will stay for a year or more, usually at the end of their lives. These residents often suffer from comorbid physical, cognitive, and mental disorders that diminish quality of life at the end of life and represent a costly burden to society. Prevention or amelioration of depression and anxiety, and improving well-being, are important for maximizing life quality and decreasing health care costs for nursing home residents.